Healthcare Provider Details

I. General information

NPI: 1740630946
Provider Name (Legal Business Name): SKILLS 4 YOU FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17906 WOODCREST WAY
CLERMONT FL
34714-5906
US

IV. Provider business mailing address

17906 WOODCREST WAY
CLERMONT FL
34714-5906
US

V. Phone/Fax

Practice location:
  • Phone: 407-989-1830
  • Fax: 863-582-9773
Mailing address:
  • Phone: 863-420-9899
  • Fax: 863-582-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberXS5786XXX
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPMH1453
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1702-001
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number557
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number557
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1578
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN897
License Number StateFL

VIII. Authorized Official

Name: DR. AGUSTIN RIVERA
Title or Position: PARTNER
Credential: MD; MC
Phone: 787-995-1429